Chapter 16: Spinal Cord Injury Transfer Training

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OUTLINE

Objectives:

The student will appropriately:

1. Demonstrate safe-guarding techniques, verbal cueing, and manual assistance when teaching transfer strategies for a client with spinal cord injury (SCI).

2. Adapt teaching of transfers based on SCI motor level, specifically tetraplegia, with and without triceps, and paraplegia.

3. Apply motor learning principles including modifying practice parameters to make the task easier or more challenging and part practice when appropriate.

4. Effectively instruct a second person in assisting a client with transfers, using appropriate guarding and handling techniques.

5. Reinforce the use of tenodesis, head-hips principle, and muscle substitution, when necessary in practice.

Introduction

Students discuss guidelines for transfer training.

Activity 1. Wheelchair Setup, Equipment Management, and Scooting

Students view videos of SCI transfers and divide into groups of three. One student acts as the physical therapist (PT), one acts as the client with SCI, and one acts as an observer. Students practice wheelchair setup, equipment management, and scooting for clients with paraplegia or tetraplegia.

Activity 2. Performing Slide Board and Swing-Through Transfers Between Surfaces

Students watch videos and practice in groups of three performing slide board and swing-through transfers for clients with paraplegia or tetraplegia on level and uphill surfaces.

Activity 3. Falling Safely From a Wheelchair and Floor Transfers

Students watch videos and practice in groups of three falling from a wheelchair and recovering from the fall if seated in the wheelchair or from the ground.

WORKSHEET

Introduction

Discuss the concepts below as they relate to the client in the video titled C6 Tetraplegia AIS B Motor Complete on McGraw Hill—use the box on the left to jump to transfers and watch the transfer from wheelchair to bed.

Guidelines for transfer training:

• Determine a technique for the individual client to achieve a long-term goal of independent and safe transfers.

• Promote neurorecovery when possible (ie, loading lower extremities [LEs] during slide board transfer; achieve a standing position if/when possible).

• Guard client with consideration of safety, level of assist, and the opportunity for the client to problem solve and increase independence.

• Adapt techniques for the client based on muscle groups available.

• Preserve tenodesis if the client has wrist extension but no active grip.

• Build upon a foundation of skills: Integrate and challenge increased stability in seated postures, either through trunk control or compensatory strategies (distal stabilization and muscle substitution) and build upon these skills as a client advances to transfer training.

• Break transfers down into parts for part-to-whole practice: see steps below.

• Basic steps to a successful transfer:

  • Wheelchair setup

  • Equipment management (ie, slide board)

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